scholarly journals Indicators of autonomic regulation of cardiovascular system subject in the acute phase of ischemic stroke with a favorable outcome

2009 ◽  
Vol 8 (3(2)) ◽  
pp. 22-26
Author(s):  
K. Ye. Kolokoltsev ◽  
N. V. Nazarenko ◽  
V. M. Kutkin

A new method of forecasting the outcome of ischemic stroke in the acute period, based on dynamic monitoring of new indicators of autonomic regulation of cardiovascular system — VIB (vegetative indicator of blood circulation), BSB (background systolic blood pressure), IDD (index of diastolic pressure). VIB allows to quantitatively assess the state of autonomic tone of the cardiovascular system, and to evaluate its dynamics, comparing with the physiological state of the patient. BSB — background systolic blood pressure, a quantitative method of assessing the standard systolic (pressor) load. IDD — an index of diastolic pressure — a way to assess the proportionality of hemodynamics. A retrospective analysis of 131 case histories of patients with ischemic stroke favorable outcome. The expression of VIB on admission and the normalization rate with the seriousness of the disease.

2020 ◽  
pp. 1-13

Abstract Background: In Japan, Pakistan and Vietnam, 0.6 mg of Alteplase per kilogram body weight within 3 hours was approved for standard guideline, although the safety and efficacy in acute ischemic stroke within 4.5 hours has not been established. We conducted four-month prospective study to compare the safety and efficacy of 0.6 mg, 0.75 mg and 0.9 mg of Alteplase per kilogram body weight. Methods: In cohort A, the patients were randomly assigned to receive intravenous 0.6 mg or 0.75 mg or 0.9 mg of Alteplase per kilogram body weight in a 1:1:1. Interim analysis was performed after complete cohort A. In cohort B, patients were assigned to receive 0.9 mg of Alteplase per kilogram body weight (standard-dose). The primary end points were death, favorable outcome at discharge and 90-day and intra-cerebral hemorrhage. The secondary end points were good outcomes, Improved mRS at discharged and 90-day, number of patients with length of hospital stay <7 days and overall complications. Results: In Cohort A, 78 were randomly assigned to receive 0.6 mg or 0.75 mg (low-dose) or 0.9 mg of intravenous Alteplase per kilogram body weight. Less patients had favorable outcomes in 0.6 mg and 7.5 mg than 0.9 mg of Alteplase per kilogram body weight at discharge (P=0.0004) and at 90-day (P=0.05). In Cohort B, 330 were assigned to receive standard-dose Alteplase. Finally, 408 patients were enrolled with median time of Alteplase administration by 2 hours 49 min. There was no different onset to needle and death between low-dose and standard-dose Alteplase (P=0.82 and P=0.85). Less patients had favorable outcome and intra-cerebral hemorrhage with low-dose than standard-dose Alteplase (favorable outcomes: Relative risk (RR), 1.18; 95% confidence interval (CI), 1.09 to 1.27; P <0.001 at discharge and RR, 1.25; 95%CI, 1.07 to 1.46; P=0.003 at 90 day, intra-cerebral hemorrhage: RR, 0.05; 95%CI, 0.00 to 0.95; P=0.04. Less patients had improved modified Rankin Scale [mRS] at 90-day with low-dose than standard-dose Alteplase (RR, 1.66; 95%CI, 1.22 to 2.25; P=0.001; especially in the patients with initial systolic blood pressure <180 mmHg ; RR, 1.86; 95%CI, 1.35 to 2.56; P=0.0001). In patients with initial systolic blood pressure >180 mmHg, low-dose Alteplase group had more patients with mRS of 0-3 at 90-day and less patients with of mRS 4-6 at 90-day than standard-dose Alteplase (P=0.002). There was no significant different in length of stay and overall complications with low-dose than standard-dose Alteplase (P=0.15). Conclusion: As compared with standard-dose, intravenous low-dose Alteplase administered within 4.5 hours after the onset of stroke significant less favorable outcome, intra-cerebral hemorrhage, but not different in death, especially in the patients with initial systolic blood pressure <180 mmHg. However, patients with initial systolic blood pressure >180 mmHg, intravenous low-dose Alteplase had less patients with disability and death and more patient’s recovery with mRS of 0-3 at 90-day. (ClinicalTrial.gov Number, NCT03847883).


2020 ◽  
Vol 117 (3) ◽  
pp. 10-16
Author(s):  
Sergej Derkach ◽  
Anna Blagaіa

Blood pressure is one of the critical indicators of a person's physiological state. This indicator and the pulse reflect the state of the cardiovascular system. Their values can directly or indirectly determine the presence of diseases of the heart and blood vessels, and other organs. Therefore, determination of blood pressure among people of different levels of health is an urgent task of modern medicine. The aim of the work: hygienic assessment and monitoring of blood pressure in medical students smoking e-cigarettes. Materials and methods: Quantitative and qualitative analysis of the level of systolic, diastolic pressure, mean arterial and pulse pressure in medical students aged 18-23 years, before and after smoking e-cigarettes was carried out. Results: The findings of the study fully reflect the importance of tonometry. Thus, the level of systolic blood pressure increased after 10 minutes by an average of 7.7%, but after 50 minutes returned to optimal value. The level of diastolic blood pressure increased after 10 minutes by an average of 8.8%, but after 50 minutes – an increase of 4%. Conclusions: This type of changes in the short period are not critical, as the body’ compensatory mechanisms stabilize hemodynamic parameters, but daily smoking can lead to the development of COPD, as well as pathology of the cardiovascular system, including myocardial ischemia or heart failure. Therefore, smoking e-cigarettes cannot be attributed to a harmless type of habit.


2019 ◽  
Vol 47 ◽  
Author(s):  
Pâmela Disarz ◽  
Paula Pancera Adams ◽  
Anderson Luiz De Carvalho ◽  
Stacy Wu ◽  
Camila Lehmckuhl de Lima ◽  
...  

Background: The black capuccin (Sapajus nigritus) is one of the most abundant primate specimens in Brazil. Among population control techniques, vasectomy can be used once it maintains the animal's leading behavior in the group through hormonal presence, production of spermatogenic series, and copula. However, due to their escape behavior, agitation, in addition to the impossibility of knowing the physiological state of these animals beforehand, their capture poses a considerable challenge. Thus, chemical restraint is indispensable and the use of effective and safe anesthetic protocols to animal integrity is of paramount importance. In this scenario, the present study aims to report the anesthesia of a black capuccin submitted to vasectomy.Case: A 1-year-old male, 1.1 kg monkey (Sapajus nigritus) was admitted at a Veterinary Hospital after being found on the ground in a natural reserve in the town of Assis Chateaubriand, in the west of Parana State. After clinical evaluation, the patient was submitted to vasectomy as a birth control method, before his return to the natural area, which presented overpopulation of the species. After preanesthetic examinations, the animal was considered healthy, and thus, premedicated with the combination of dexmedetomidine (10 μg/kg) and ketamine (10 mg/kg), intramuscularly. Anesthetic induction with propofol was performed to effect. Laringeal desensitization was achieved with 2% lidocaine (2 mg/kg), which allowed orotracheal intubation through direct visualization. Anesthesia was maintained with 1% isoflurane in a 0.5 oxygen fraction and spontaneous ventilation using a non-rebreathing circuit. The spermatic cord and the skin were desensitized with lidocaine (2 mg/kg). During the procedure, the animal was monitored for pulse oximetry, electrocardiogram, systolic blood pressure, body temperature, end tidal CO2 (ETCO2), and end tidal isoflurane. The animal also received 10 mL/kg/h ringer lactate throughout anesthesia and 30 mg/kg ampiciline as prophylactic antibiotic. After the completion of the surgery, inhalation anesthesia was interrupted and the animal was allowed to wake up.  Discussion: The combination of 10 µg/kg dexmedetomidine and 10 mg/kg ketamine caused intense muscle relaxation and short-term sedation, which lasted 15 min. Protocol was sufficient for veno puncture and pre-oxygenation, but doses should be increased for longer procedures. Although other authors reported physiologic alterations with higher doses of these drugs, such complications were not observed in the present case. The anesthetic induction was smooth, with no excitement or complications. Propofol was infused at 1 mg/10 s, and a total dose of 10 mg/kg was necessary for induction. This rapid infusion rate could have caused the increase in propofol total dose, as described elsewhere. Propofol and local lidocaine allowed orotracheal intubation with a 2.5 mm uncuffed neonatal tube. During surgery, analgesia was achieved with pre surgical local anesthetic and a single bolus of fentanyl during duct deferens manipulation. During anesthesia, heart rate was maintained between 140 and 170 bpm; systolic blood pressure, between 85 and 110 mmHg; respiratory rate, between 30 and 50 mpm; and ETCO2, between 25 and 30 mmHg. No assistance in ventilation was necessary. The procedure lasted one hour, and extubation occurred seven minutes after the interruption of inhalational anesthetic. Anesthesia and anesthesia recovery occurred without complications, allowing the accomplishment of a short duration surgical procedure. After the post operatory period, the animal was reintroduced to the wild, with authorization of the state environmental agency. In conclusion, low dose dexmedetomidine combined with ketamine is adequate for rapid chemical restraint of black capuccin, and do not cause physiologic alterations during isoflurane anesthesia.


2021 ◽  
pp. neurintsurg-2021-017963
Author(s):  
Gang Deng ◽  
Jun Xiao ◽  
Haihan Yu ◽  
Man Chen ◽  
Ke Shang ◽  
...  

BackgroundDespite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.MethodsPubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.ResultsTwelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD −0.71, 95% CI −1.23 to –0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.ConclusionThis study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Yong-Jin Cho ◽  
Keun-Sik Hong ◽  
Jun Lee ◽  
...  

Background: Blood pressure of ischemic stroke patients is a potentially modifiable clinical prognostic factor during acute period. However, BP changes dynamically over time and its temporal variation during acute stage has not received much attention. Methods: From a total of 3795 acute ischemic stroke patients who arrived within 24 hours after onset, we selected 2723 eligible patients who had more than 5 systolic blood pressure (SBP) measurements during 24 hours after arrival. To predict group SBPs for 8 time-points during the first 24 hours, a measured SBP reading was imputed to the nearest missing point. Trajectory grouping of acute stroke patients was estimated using PROC TRAJ, with delta BIC and prespecified modeling parameters. Early neurological deterioration (END) was captured during admission and recurrent vascular events was collected through a structured telephone interview at 1 years after. Results: Of the included cases, mean age at onset was 68 ± 13 year-old. NIHSS score at arrival was median 4 [2, 10] and recanalization treatment was done in 598 (22%). Hypertension was diagnosed in 1930 (71%). Based on 48,445 SBP readings during the first 24 hours after arrival, stroke cases were grouped into 5 distinct SBP trajectories as shown in the Figure: Group 1 (low BP), 17%; Group 2 (stable BP), 41%; Group 3 (rapidly stabilized SBP), 11%; Group 4 (higher SBP), 23%; Group 5 (extremely high SBP without stabilization), 8%. Trajectory grouping was independently associated with END and recurrent vascular events (see Figure). Group 1 had low odds of having END (adjusted OR [95% CI]; 0.62 [0.44-0.87], but Group 4 and 5 showed higher probability of having END (1.34 [1.04-1.73] and 1.76 [1.22-2.51]) and recurrent vascular events until 1 year (1.28 [1.00-1.64] and 1.82 [1.29-2.55]). However, Group 3 had comparable risks with Group 2. Conclusion: It was documented that SBP may successfully grouped into distinct trajectories, which are associated with outcomes after stroke.


2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Margaret Moores ◽  
Vignan Yogendrakumar ◽  
Olena Bereznyakova ◽  
Walid Alesefir ◽  
Hailey Pettem ◽  
...  

1979 ◽  
Vol 57 (s5) ◽  
pp. 393s-396s ◽  
Author(s):  
L. A. Salako ◽  
A. O. Falase ◽  
A. Fadeke Aderounmu

1. The β-adrenoreceptor-blocking effects of pindolol were compared with those of propranolol and a placebo in a double-blind cross-over trial involving nine hypertensive African patients. 2. Heart rate, systolic blood pressure and diastolic blood pressure were measured at rest and immediately after exercise before and at intervals up to 6 h after oral administration of the drugs. In addition, plasma pindolol and propranolol concentrations were determined at the same intervals. 3. Pindolol diminished systolic blood pressure at rest and after exercise and antagonized exercise-induced tachycardia, but had no effect on resting heart rate. Propranolol diminished systolic blood pressure predominantly after exercise and reduced both resting and exercise heart rate. Both drugs had no effect on diastolic pressure. 4. The mean plasma concentration reached a peak at 2 h for each drug and this coincided with the interval at which maximal β-adrenoreceptor-blocking effect was observed.


PLoS ONE ◽  
2019 ◽  
Vol 14 (10) ◽  
pp. e0224293
Author(s):  
Seo Hyun Kim ◽  
Ji In Kim ◽  
Ji-Yong Lee ◽  
Chan Ik Park ◽  
Jin Yong Hong ◽  
...  

1997 ◽  
Vol 83 (2) ◽  
pp. 371-375 ◽  
Author(s):  
Oommen P. Mathew

Mathew, Oommen P. Effects of transient intrathoracic pressure changes (hiccups) on systemic arterial pressure. J. Appl. Physiol. 83(2): 371–375, 1997.—The purpose of the study was to determine the effect of transient changes in intrathoracic pressure on systemic arterial pressure by utilizing hiccups as a tool. Values of systolic and diastolic pressures before, during, and after hiccups were determined in 10 intubated preterm infants. Early-systolic hiccups decreased systolic blood pressure significantly ( P < 0.05) compared with control (39.38 ± 2.72 vs. 46.46 ± 3.41 mmHg) and posthiccups values, whereas no significant change in systolic blood pressure occurred during late-systolic hiccups. Diastolic pressure immediately after the hiccups remained unchanged during both early- and late-systolic hiccups. In contrast, diastolic pressure decreased significantly ( P < 0.05) when hiccups occurred during diastole (both early and late). Systolic pressures of the succeeding cardiac cycle remained unchanged after early-diastolic hiccups, whereas they decreased after late-diastolic hiccups. These results indicate that transient decreases in intrathoracic pressure reduce systemic arterial pressure primarily through an increase in the volume of the thoracic aorta. A reduction in stroke volume appears to contribute to the reduction in systolic pressure.


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